Author
According to the LITP, asylees and foreigners under subsidiary protection shall exercise the right to health care pursuant to the regulations governing health insurance and health care of foreigners in the Republic of Croatia.[1] The costs of health care shall be paid from the State Budget under the item of the Ministry competent for health care.
The Law on Compulsory Health Insurance and Health Care for Foreigners in the Republic of Croatia prescribes that asylees, foreigners under subsidiary protection, foreigners under temporary protection and their family members have the right to health care[2] to the same extent as health insured persons under mandatory health insurance.[3]
According to the Law on Compulsory Health Insurance and Health Care for Foreigners in the Republic of Croatia, the right to health care is provided on the basis of a valid document issued by the Ministry of Interior.[4] The competent police administration or police station is obliged to notify the ministry competent for health that asylum, subsidiary protection or temporary protection was granted to foreigner, at the latest within eight days from the date of execution of the decision granting protection .[5]
This means that there is a difference between the unemployed and employed beneficiaries of international protection. Unemployed beneficiaries of international protection are not insured within the Croatian Health Insurance Fund, but the costs of their health care are covered from the State budget from the position of the ministry responsible for health. In the case of unemployed beneficiaries, health care providers should send invoices, a copy of the residence permit and accompanying medical documentation directly to the Ministry of Health. This category of beneficiaries does not have a health insurance card but prove their status with a residence permit card. Also, they do not have an identity number of the insured person nor are they in the Central Health Information System. When a beneficiary of international protection gets a job and starts paying health insurance contributions, s/he becomes insured. However, unlike Croatian citizens, their family members cannot acquire the right to compulsory health insurance through their insured relative, but costs continue to be covered by the State budget through the Ministry of Health. If a beneficiary of international protection losses employment, he/she ceases to be insured by Croatian Health Insurance Fund.[6] However in practice, healthcare professionals are not sufficiently familiar with the rights of beneficiaries of international protection and the way in which they can exercise their right to health care.
In 2020, the Ministry of Health provided instructions to relevant health care institutions and pharmacies on the way that medicines should be provided to asylees and persons under subsidiary protection.[7] According to these instructions, the pharmacy delivers an invoice addressed to the Ministry of Health and to the Croatian Health Insurance Fund. A prescription form and a copy of a document issued by the Ministry of the Interior which shows the status of the foreigner to whom the invoice was issued, should be attached to the invoice. The Croatian Health Insurance Fund subsequently submits an invoice for payment to the Ministry of Health after having reviewed the conformity of the medicines prescribed. If it is a medicine that is on the basic list of medicines of the Croatian Health Insurance Fund, the price of the medicine is borne entirely by the Ministry of Health, while in the case of a medicine from the supplementary list, the price is partly borne by the person and partly by the Ministry of Health. If a person is issued a private prescription, the person bears the full cost of the medicine.
The Ombudswoman’s report for 2023 emphasized that although the LITP states that persons under international protection have the right to health care in accordance with the Law on Compulsory Health Insurance and Health Care for Foreigners, there are difficulties in the implementation of these laws. Most notably, the patient registration systems in hospitals do not provide for the entry of the category of person under international protection, except possibly under the general rubric “notes”. In addition, beneficiaries of international protection are not issued insurance cards or the identity number of the insured person, they are not registered in the central system of insured persons (the so-called CEZIH), and health institutions are not familiar with the procedures for issuing referrals and prescriptions for persons under international protection. Hospitals and doctors do not have relevant and clear information on how to efficiently and quickly provide them with health care services. Beneficiaries of international protection cannot contract supplementary health insurance, unless they are employed or have a long-term residence. The Ombudswoman also reported about the problem of translation during visits to the doctor, which has not been systematically solved. CSOs pointed to several discriminatory behaviours of doctors and health workers who did not want to examine and treat refugees.[8]
Problems in the health system were reported by Are You Syrious, the Centre for Peace Studies and the Rehabilitation Centre for Stress and Trauma.
In course of 2023, AYS[9] provided information on the scope of the right to health care to beneficiaries of international protection, but also assisted them with enrolment procedures or when persons undertook medical examinations. AYS highlighted that the non-recognition of the right to health care for beneficiaries of international protection remains a shortcoming.
The same challenges were reported by the Centre for Peace Studies (CPS). In addition, according to CPS, pharmacies are also not informed about the procedure for dispensing medicines to persons under international protection. Therefore, beneficiaries of international protection’s requests are often rejected. CPS also reported that some beneficiaries were treated discriminatorily by doctors and health workers. Due to observed shortcomings, CPS has initiated the Network for Improving the Access to Healthcare Services, made up of representatives of civil society organizations, public bodies at the local and state level, and experts in the field of integration. The aim is to jointly review perceived problems in access to healthcare services, exchange information and experiences in the field of healthcare, look at potential solutions and develop examples of good practices that would improve certain aspects of access to health services. The activities are part of the project “Accessing services, Sharing Approaches and Practices- ASAP” co-financed by AMIF and the Office for NGOs of the Government of the Republic of Croatia. Through joint discussions in the Network, the need for interpretation support when accessing the health system and various health examinations was detected. A pilot practice aimed at creating a network of interpreters who provide interpretation support to persons under international and temporary protection was developed. CPS published a Guide for citizens of third countries on access to healthcare in Croatia.[10] The guide contains information about the basic terms that people face when accessing the health system and when communicating with doctors and other health service providers in Croatia. The guide also contains instructions on how to find a primary care doctor and other useful instructions for accessing healthcare in Croatia. In addition to the Guide, CPS has created video materials on the e-Citizens Portal,[11] and Finding General Practitioners and Gynaecologists for foreigners in the Republic of Croatia.[12] The guide and video materials are available in Croatian, English, French, Arabic and Ukrainian.[13]
[1] Article 69(1)-(2) LITP.
[2] Article 17 Law on Compulsory Health Insurance and Health Care for Foreigners in the Republic of Croatia.
[3] Article 21(1) Law on Compulsory Health Insurance and Health Care for Foreigners in the Republic of Croatia.
[4] Article 21(2) Law on Compulsory Health Insurance and Health Care for Foreigners in the Republic of Croatia.
[5] Article 21(3) Law on Compulsory Health Insurance and Health Care for Foreigners in the Republic of Croatia.
[6] Croatian Association of Social Workers: Handbook- The role of social welfare in the process of integration of persons with international protection, available at: https://bit.ly/3uti9M5.
[7] Ministry of Health: Letter from the Ministry of Health to Croatian Health Insurance Fund, 15 July 2020, available at: https://bit.ly/3tD9kh1.
[8] Ombudswoman, Report of the Ombudswoman for 2023, available in Croatian at: https://bit.ly/4crt2kR.
[9] Information provided by Are you Syrious, 29 January 2024.
[10] Centre for Peace Studies: Guide for citizens of third countries on access to healthcare in Croatia, available at: https://bit.ly/4cqVq6G.
[11] e-Citizens is a central point for all public sector information and services in Croatia.
[12] Video materials available at: https://bit.ly/3xsDABh.
[13] Information provided by Centre for Peace Studies, 30 January 2024.